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Guerzoni ME, Marchesi S, Palazzi G, Lodi M, Pinelli M, Venturelli D, Bigi E, Quaglia N, Corti P, Serra R, Colombatti R, Sainati L, Masera N, Colombo F, Barone A, Iughetti L. Environmental Factors in Northern Italy and Sickle Cell Disease Acute Complications: A Multicentric Study. Children (Basel) 2022; 9:1478. [PMID: 36291415 PMCID: PMC9600492 DOI: 10.3390/children9101478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Environmental factors seem to influence clinical manifestations of sickle cell disease (SCD), but few studies have shown consistent findings. We conducted a retrospective multicentric observational study to investigate the influence of environmental parameters on hospitalization for vaso-occlusive crises (VOC) or acute chest syndrome (ACS) in children with SCD. METHODS Hospital admissions were correlated with daily meteorological and air-quality data obtained from Environmental Regional Agencies in the period 2011-2015. The effect of different parameters was assessed on the day preceding the crisis up to ten days before. Statistical analysis was performed using a quasi-likelihood Poisson regression in a generalized linear model. RESULTS The risk of hospitalization was increased for low maximum temperature, low minimum relative humidity, and low atmospheric pressure and weakly for mean wind speed. The diurnal temperature range and temperature difference between two consecutive days were determined to be important causes of hospitalization. For air quality parameters, we found a correlation only for high levels of ozone and for low values at the tail corresponding to the lowest concentration of this pollutant. CONCLUSIONS Temperature, atmospheric pressure, humidity and ozone levels influence acute complications of SCD. Patients' education and the knowledge of the modes of actions of these factors could reduce hospitalizations.
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Affiliation(s)
- Maria Elena Guerzoni
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Stefano Marchesi
- Arpae-Agenzia Regionale per la Prevenzione, L’ambiente e L’energia dell’Emilia, Romagna, 41121 Modena, Italy
| | - Giovanni Palazzi
- Oncology and Hematology Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Mariachiara Lodi
- Department of Medical and Surgical Sciences for Mothers, Child and Adults, Post Graduate School of Pediatrics, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Margherita Pinelli
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Donatella Venturelli
- Department of Transfusion Medicine, University Hospital of Modena, 41124 Modena, Italy
| | - Elena Bigi
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Nadia Quaglia
- Clinic of Pediatric Hematology Oncology, Department of Woman’s and Child’s Health, University Hospital of Padova, 35128 Padova, Italy
| | - Paola Corti
- Department of Pediatrics, University of Milano Bicocca, Fondazione MBBM, 20900 Monza, Italy
| | - Roberta Serra
- Pediatric Onco-Hematology, Department of Pediatrics, University Hospital of Parma, 43126 Parma, Italy
| | - Raffaella Colombatti
- Clinic of Pediatric Hematology Oncology, Department of Woman’s and Child’s Health, University Hospital of Padova, 35128 Padova, Italy
| | - Laura Sainati
- Clinic of Pediatric Hematology Oncology, Department of Woman’s and Child’s Health, University Hospital of Padova, 35128 Padova, Italy
| | - Nicoletta Masera
- Department of Pediatrics, University of Milano Bicocca, Fondazione MBBM, 20900 Monza, Italy
| | - Francesca Colombo
- Department of Pediatrics, University of Milano Bicocca, Fondazione MBBM, 20900 Monza, Italy
| | - Angelica Barone
- Pediatric Onco-Hematology, Department of Pediatrics, University Hospital of Parma, 43126 Parma, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Oncology and Hematology Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Department of Medical and Surgical Sciences for Mothers, Child and Adults, Post Graduate School of Pediatrics, University of Modena and Reggio Emilia, 41121 Modena, Italy
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Imbriaco G, Monesi A, Giugni A, Ferrari P, Bigi E, Menarini M. High-Fidelity Simulation Training for Helicopter Emergency Medical Services Flight Nurses: A Report From the First Italian Experience. Air Med J 2021; 40:264-268. [PMID: 34172235 DOI: 10.1016/j.amj.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/26/2021] [Accepted: 03/09/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Simulation-based training has a significant effect in enhancing professionals' skills in the helicopter emergency medical service (HEMS) setting and is reported to be more effective than other learning strategies. The main objective of this study was to assess the efficacy of a specific high-fidelity simulation (HFS) training course for HEMS nurses before entering into operational service. METHODS This report describes the first Italian experience of a specifically designed HFS training program for HEMS nurses held in Bologna, Italy, in a dedicated scenario with a mock-up helicopter and an advanced mannequin. RESULTS A total of 14 nurses participated in the SAFE2019 (Simulazione ad Alta Fedeltà per l'Elisoccorso-High-Fidelity Simulation for HEMS) courses. The aspects considered most useful and effective were related to team working, communication issues, and nontechnical skills (NTS) development. Moreover, participants suggested implementing a series of scheduled HFS retraining sessions. CONCLUSION HFS in a dedicated HEMS scenario during the orientation period has contributed to enhanced technical competencies and NTS, increasing comfort and situational awareness for new entrant flight nurses. Simulation may represent a valuable resource to assess and maintain competencies through periodic retraining sessions for full HEMS teams or when new devices are adopted.
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Affiliation(s)
- Guglielmo Imbriaco
- Intensive Care Unit, Maggiore Hospital, Bologna, Italy; Helicopter Emergency Medical Service, Maggiore Hospital, Bologna, Italy; Critical Care Nursing Master Course, University of Bologna, Bologna, Italy.
| | - Alessandro Monesi
- Intensive Care Unit, Maggiore Hospital, Bologna, Italy; Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
| | - Aimone Giugni
- Helicopter Emergency Medical Service, Maggiore Hospital, Bologna, Italy; Division of Anesthesia, Intensive Care, and Prehospital Emergency, Maggiore Hospital, Bologna, Italy
| | | | - Elena Bigi
- Helicopter Emergency Medical Service, Maggiore Hospital, Bologna, Italy; Division of Anesthesia, Intensive Care, and Prehospital Emergency, Maggiore Hospital, Bologna, Italy
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Bruzzi P, Bigi E, Felici F, Lami F, Cano Garcinuno MDC, Giovanni P, Cellini M, Predieri B, Iughetti L. Markers of Inflammation and Endothelial Dysfunction in Young Survivors from Acute Lymphoblastic Leukemia. J Adolesc Young Adult Oncol 2020; 10:599-605. [PMID: 33237835 DOI: 10.1089/jayao.2020.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To assess subclinical markers of endothelial inflammation in young survivors from acute lymphoblastic leukemia (ALL) treated with chemotherapy without cranial irradiation. Methods: Anthropometric parameters [height (H), body mass index (BMI), waist circumference (WC), hip circumference (HC), WC/H, and WC/HC ratio], blood pressure, lipid profile, serum markers of inflammation and endothelial dysfunction [Interleukin 6 (IL-6), vascular cell adhesion molecule, intercellular adhesion molecule, tumor necrosis factor-alfa (TNF-α), Endogenous secretory Receptor for Advanced Glycation Endproducts (Es-RAGE)], and carotid intima-media thickness (c-IMT) were assessed in a group of young ALL survivors and in matched controls. Local Ethics Committee approved the study (code 56/13) on June 24, 2013. Results: 28 ALL survivors (71% male, 18% prepubertal, aged 15.98 ± 4.41 years, mean follow-up 8.57 ± 3.14 years) exhibited lower levels of Es-RAGE than controls (0.18 ± 0.07 vs. 0.27 ± 0.08 ng/mL, p < 0.001). Among survivors, Es-RAGE values significantly correlated with BMI-SD off-therapy (R2 -0.42), WC/H ratio (R2 -0.41), WC/HC ratio (R2 -0.38), and low-density-lipoprotein cholesterol (LDL-C; R2 -0.43). Most of the ALL survivors (78%) presented c-IMT above the 95th centile if compared with gender and age standard. Mean c-IMT value correlated with blood pressure (R2 0.56) and with LDL-C levels (R2 0.56). Metabolic syndrome (MetS) was fully detected only in one ALL survivor. Nevertheless, 18% ALL survivors presented more than one MetS diagnostic criteria: 14% insulin resistance, 25% dyslipidemia, and 17.8% hypertension. Conclusion: We demonstrated an initial functional vascular alteration in young ALL survivors even when treated with standard risk protocols. Our data already support the activation at endothelial level of glycosylation and oxidation processes that are persistent long after the end of the treatment.
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Affiliation(s)
- Patrizia Bruzzi
- Pediatric Unit and Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Bigi
- Pediatric Oncology and Hematology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Felici
- Department of Medical and Surgical Sciences for Mothers, Children and Adults, Post Graduate School of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Lami
- Pediatric Unit and Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Del Carmen Cano Garcinuno
- Pediatric Oncology and Hematology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Palazzi Giovanni
- Pediatric Oncology and Hematology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Monica Cellini
- Pediatric Oncology and Hematology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Predieri
- Pediatric Unit and Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit and Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.,Pediatric Oncology and Hematology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.,Department of Medical and Surgical Sciences for Mothers, Children and Adults, Post Graduate School of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy
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Predieri B, Bruzzi P, Bigi E, Boncompagni A, Bocchi F, Cenciarelli V, Madeo SF, Poluzzi S, Pugliese M, Toffoli C, Lucaccioni L, Iughetti L. Health-related quality of life and metabolic control in immigrant and Italian children and adolescents with type 1 diabetes and in their parents. Pediatr Diabetes 2020; 21:1031-1042. [PMID: 32418308 DOI: 10.1111/pedi.13042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/23/2020] [Accepted: 05/08/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To determine if the diabetes-specific health-related quality of life (D-HRQOL) of young people with type 1 diabetes (T1D) and their parents is influenced by migrant status. SUBJECTS AND METHODS One hundred and twenty-five patients (12.4 ± 3.55 years, males 53.6%) with T1D and their parents (102 mothers, 37 fathers) were enrolled and categorized into: group A (both foreign parents) and group B (both native Italian parents). The Pediatric Quality of Life Inventory™ 3.0 Diabetes Module (PedsQL™ 3.0 DM) was used to evaluate the D-HRQOL. Data on diabetic ketoacidosis (DKA) at T1D onset, insulin therapy, and glycosylate hemoglobin (HbA1c) were also collected. RESULTS Group A (n = 40), compared to group B (n = 85), had higher frequency of DKA at T1D onset (P < .001) and a lower use of sensor augmented insulin pump (P = .015). HbA1c values were higher in group A than in group B (P < .001). Patients' "Diabetes symptoms" (P = .004), "Treatment barriers" (P = .001), and "Worry" (P = .009) scales scores were lower in group A than in group B. Mothers of group A had lower scores in "Diabetes symptoms" (P = .030), "Treatment barriers" (P < .001), "Treatment adherence" (P = .018), "Communication" (P = .009) scales, and total score (P = .011) compared to the group B ones. High PedsQL™ 3.0 DM was significantly associated with being Italian, being prepubertal, and having lower HbA1c mean levels. CONCLUSIONS Being a migrant confers disadvantages in terms of D-HRQOL and metabolic control in children and adolescents with T1D. Specific educational interventions should be considered in the clinical care of patients with migration background, to improve D-HRQOL and health status.
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Affiliation(s)
- Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy.,Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Patrizia Bruzzi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Bigi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Boncompagni
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Bocchi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Cenciarelli
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Simona F Madeo
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Poluzzi
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Marisa Pugliese
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy
| | - Carlotta Toffoli
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Lucaccioni
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy.,Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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Predieri B, Bruzzi P, Bigi E, Ciancia S, Madeo SF, Lucaccioni L, Iughetti L. Endocrine Disrupting Chemicals and Type 1 Diabetes. Int J Mol Sci 2020; 21:ijms21082937. [PMID: 32331412 PMCID: PMC7215452 DOI: 10.3390/ijms21082937] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022] Open
Abstract
Type 1 diabetes (T1D) is the most common chronic metabolic disease in children and adolescents. The etiology of T1D is not fully understood but it seems multifactorial. The genetic background determines the predisposition to develop T1D, while the autoimmune process against β-cells seems to be also determined by environmental triggers, such as endocrine disrupting chemicals (EDCs). Environmental EDCs may act throughout different temporal windows as single chemical agent or as chemical mixtures. They could affect the development and the function of the immune system or of the β-cells function, promoting autoimmunity and increasing the susceptibility to autoimmune attack. Human studies evaluating the potential role of exposure to EDCs on the pathogenesis of T1D are few and demonstrated contradictory results. The aim of this narrative review is to summarize experimental and epidemiological studies on the potential role of exposure to EDCs in the development of T1D. We highlight what we know by animals about EDCs’ effects on mechanisms leading to T1D development and progression. Studies evaluating the EDC levels in patients with T1D were also reported. Moreover, we discussed why further studies are needed and how they should be designed to better understand the causal mechanisms and the next prevention interventions.
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Affiliation(s)
- Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults-University of Modena and Reggio Emilia, Largo del Pozzo, 71-41124 Modena, Italy; (E.B.); (L.I.)
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults—University of Modena and Reggio Emilia, Largo del Pozzo, 71-41124 Modena, Italy;
- Correspondence: ; Tel.: +39-059-422-5217
| | - Patrizia Bruzzi
- Pediatric Unit, Department of Pediatrics—AOU Policlinic of Modena, Largo del Pozzo, 71-41124 Modena, Italy; (P.B.); (S.F.M.)
| | - Elena Bigi
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults-University of Modena and Reggio Emilia, Largo del Pozzo, 71-41124 Modena, Italy; (E.B.); (L.I.)
| | - Silvia Ciancia
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults—University of Modena and Reggio Emilia, Largo del Pozzo, 71-41124 Modena, Italy;
| | - Simona F. Madeo
- Pediatric Unit, Department of Pediatrics—AOU Policlinic of Modena, Largo del Pozzo, 71-41124 Modena, Italy; (P.B.); (S.F.M.)
| | - Laura Lucaccioni
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults-University of Modena and Reggio Emilia, Largo del Pozzo, 71-41124 Modena, Italy;
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults-University of Modena and Reggio Emilia, Largo del Pozzo, 71-41124 Modena, Italy; (E.B.); (L.I.)
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults—University of Modena and Reggio Emilia, Largo del Pozzo, 71-41124 Modena, Italy;
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Iughetti L, Lucaccioni L, Bruzzi P, Ciancia S, Bigi E, Madeo SF, Predieri B, Roucher-Boulez F. Isolated hypoaldosteronism as first sign of X-linked adrenal hypoplasia congenita caused by a novel mutation in NR0B1/DAX-1 gene: a case report. BMC Med Genet 2019; 20:98. [PMID: 31164167 PMCID: PMC6549270 DOI: 10.1186/s12881-019-0834-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/23/2019] [Indexed: 11/10/2022]
Abstract
Background X-linked Adrenal Hypoplasia Congenita (AHC) is a rare cause of primary adrenal insufficiency due to mutations in the NR0B1 gene, causing a loss of function of the nuclear receptor protein DAX-1. Adrenal insufficiency usually appears in the first 2 months of life, but can sometimes emerge during childhood. Hypogonadotropic Hypogonadism is often associated later in life and patients may develop azoospermia. We describe an unusual onset of AHC started with isolated hypoaldosteronism as first and only sign of the disease. Case presentation A 18-days-old newborn presented with failure to thrive and feeding difficulties. Blood tests showed severe hyponatremia, hyperkalemia and hypochloremia. Renin was found over the measurable range and aldosterone was low whereas cortisol level was normal with a slightly increased ACTH. In the suspicion of Primary Hypoaldosteronism, correction of plasmatic electrolytes and replacement therapy with Fludrocortisone were promptly started. The subsequent evidence of low plasmatic and urinary cortisol and increased ACTH required the start of Hydrocortisone replacement therapy and it defined a clinical picture of adrenal insufficiency. Genetic analysis demonstrated a novel mutation in the DAX-1 gene leading to the diagnosis of AHC. Conclusions AHC onset may involve the aldosterone production itself, miming an isolated defect of aldosterone synthesis. NR0B1/DAX-1 mutations should be considered in male infants presenting with isolated hypoaldosteronism as first sign of adrenal insufficiency.
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Affiliation(s)
- Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124, Modena, Italy.
| | - Laura Lucaccioni
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124, Modena, Italy
| | - Patrizia Bruzzi
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124, Modena, Italy
| | - Silvia Ciancia
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124, Modena, Italy
| | - Elena Bigi
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124, Modena, Italy
| | - Simona Filomena Madeo
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124, Modena, Italy
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo n. 71, 41124, Modena, Italy
| | - Florence Roucher-Boulez
- Laboratoire de Biochimie et Biologie Moléculaire Grand Est, UM Pathologies Endocriniennes Rénales Musculaires et Mucoviscidose, Groupement Hospitalier Est, Hospices Civils de Lyon, Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France
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Fontana F, Giovanella S, Ligabue G, Alfano G, Lodi M, Bigi E, Palazzi G, Varani M, Iughetti L, Cappelli G. FP808EARLY IDENTIFICATION OF SICKLE CELL NEPHROPATHY IN A COHORT OF CHILDREN WITH SICKLE CELL DISEASE. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | - Elena Bigi
- University of Modena and Reggio Emilia, Modena, Italy
| | | | - Manuela Varani
- Azienda Unita' Sanitaria Locale Di Modena, Modena, Italy
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Mandese V, Bigi E, Bruzzi P, Palazzi G, Predieri B, Lucaccioni L, Cellini M, Iughetti L. Endocrine and metabolic complications in children and adolescents with Sickle Cell Disease: an Italian cohort study. BMC Pediatr 2019; 19:56. [PMID: 30744584 PMCID: PMC6371531 DOI: 10.1186/s12887-019-1423-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 01/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with Sickle Cell Disease (SCD) show endocrine complications and metabolic alterations. The physiopathology of these conditions is not completely understood: iron overload due to chronic transfusions, ischemic damage, and inflammatory state related to vaso-occlusive crises may be involved. Aims of this study were to evaluate the growth pattern, endocrine complications, and metabolic alterations and to detect the relationship between these conditions and the SCD severity in affected children and adolescents. METHODS Fifty-two children and adolescents with SCD [38 homozygous sickle hemoglobin (HbSS) and 14 heterozygous sickle hemoglobin (HbSC); age range 3-18 years] were recruited. Anthropometric [height, body mass index (BMI), arm span, sitting height, target height (TH), and pubertal status] and laboratory [blood cell counts, hemolysis indices, metabolic and nutritional status indices and hormonal blood levels] data were evaluated. The SCD severity was defined according to hematological and clinical parameters. RESULTS Height-SDS adjusted for TH and BMI-SDS were significantly higher in HbSC children than in HbSS ones. Forty-eight out of 52 patients (92%) had at least one metabolic and/or endocrine alteration: insufficiency/deficiency of vitamin D (84.7%), insulin resistance (11.5%), growth hormone deficiency (3.8%), subclinical hypothyroidism (3.8%), and hypogonadism (1.9%). Levels of vitamin D were significantly and negatively correlated with clinical indicators of the SCD severity. Subjects with HbSS genotype show significant lower levels of both insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein 3 than children with HbSC. In the study population IGF-1 values were significantly and positively correlated with Hb and negatively with lactate dehydrogenase. CONCLUSIONS Metabolic alterations and endocrine complications are very common in children and adolescents with SCD. A regular follow-up is necessary to identify subjects at risk for complications to precociously start an appropriate treatment and to improve the quality of life of SCD patients.
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Affiliation(s)
- V Mandese
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - E Bigi
- Oncology and Hematology Pediatric Unit Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - P Bruzzi
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - G Palazzi
- Oncology and Hematology Pediatric Unit Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - B Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - L Lucaccioni
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - M Cellini
- Oncology and Hematology Pediatric Unit Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - L Iughetti
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy. .,Oncology and Hematology Pediatric Unit Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy. .,Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy.
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Bruzzi P, Bigi E, Predieri B, Bonvicini F, Cenciarelli V, Felici F, Iughetti L. Long-term effects on growth, development, and metabolism of ALL treatment in childhood. Expert Rev Endocrinol Metab 2019; 14:49-61. [PMID: 30596296 DOI: 10.1080/17446651.2019.1561271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 12/17/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION One aim of the long-term care in survivors from acute lymphoblastic leukemia (ALL) during childhood is to avoid or limit complications caused by aggressive therapeutic strategies. AREAS COVERED ALL survivors are a heterogeneous group according to therapeutic protocols. In the last decades, cranial radiotherapy (cRT) has been largely replaced by intrathecal chemotherapy (CT) with a reduction of endocrine sequelae. Published studies are generally difficult to be interpreted because patients were treated according to different risk-adapted protocols and results are conflicting. We perform this review on endocrine long-term effects in childhood ALL survivors focusing on studies published in the last decades. Articles were selected using the following terms (Mesh terms): 'acute lymphoblastic leukemia' AND 'survivors' AND 'childhood' AND 'growth/puberty/fertility/obesity/metabolic syndrome/bone'. EXPERT COMMENTARY Most childhood ALL survivors treated with CT alone attain normal height and have adequate pubertal development. Despite recent protocols improvements, ALL survivors still develop long-term metabolic complications (overweight, obesity, and cardiovascular disease) especially the female gender and patients with an increased body mass index (BMI) at diagnosis. The aim of this review is to describe the state of the art on these topics. We should be able to anticipate, prevent, and treat endocrine long-term morbidities through a well-established follow-up strategy.
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Affiliation(s)
- Patrizia Bruzzi
- a Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Elena Bigi
- b Oncology and Hematology Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Barbara Predieri
- a Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Federico Bonvicini
- c Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Valentina Cenciarelli
- c Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Francesca Felici
- c Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Lorenzo Iughetti
- c Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
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Lodi M, Bigi E, Palazzi G, Vecchi L, Morandi R, Setti M, Borsari S, Bergonzini G, Iughetti L, Venturelli D. Universal Screening Program in Pregnant Women and Newborns at-Risk for Sickle Cell Disease: First Report from Northern Italy. Hemoglobin 2017; 41:230-233. [PMID: 29233055 DOI: 10.1080/03630269.2017.1405820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The implementation of screening programs for early detection of patients with sickle cell disease has become necessary in Italy as a result of the high rate of migration from areas with a high prevalence of the disease (Sub-Saharan Africa, Middle East and the Balkans). Following a pilot study performed in the province of Modena, Italy in 2011-2013, an official screening program was established on May 31 2014 for all pregnant women, free-of-charge for the family according to the National Guidelines for Physiological Pregnancy. Hemoglobin (Hb) profiles of pregnant women within 10 weeks of pregnancy, of new mothers at delivery and of the newborns of mothers with variant Hb profiles (newborns at-risk), were evaluated by high performance liquid chromatography (HPLC). Samples from 17,077 new mothers were analyzed and 993 showed alteration of Hb patterns (5.8%) (1.0% Hb AS carriers); of the 1011 at-risk newborns, four (0.4%) carried sickle cell disease and 90 (8.9%) were Hb AS carriers. These data show that early diagnosis of sickle cell disease or carrier status can be obtained in high-risk newborns, providing valuable information on the frequency of these conditions in geographic areas in which the disease is historically rare.
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Affiliation(s)
- Mariachiara Lodi
- a Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Elena Bigi
- b Oncology and Hematology Pediatric Unit, Department of Medical and Surgical Science for Mothers Children and Adults , University Hospital of Modena , Modena , Italy
| | - Giovanni Palazzi
- b Oncology and Hematology Pediatric Unit, Department of Medical and Surgical Science for Mothers Children and Adults , University Hospital of Modena , Modena , Italy
| | - Lara Vecchi
- c Transfusion Medicine Department , University Hospital of Modena , Modena , Italy
| | - Riccardo Morandi
- c Transfusion Medicine Department , University Hospital of Modena , Modena , Italy
| | - Monica Setti
- d Clinical Engineering , Local Primary Health Care of Modena , Modena , Italy
| | - Silvana Borsari
- e Community Women Health Clinic, Local Primary Health Care of Modena , Modena , Italy
| | - Giuliano Bergonzini
- f Laboratory Medicine Department , University Hospital of Modena , Modena , Italy
| | - Lorenzo Iughetti
- a Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy.,b Oncology and Hematology Pediatric Unit, Department of Medical and Surgical Science for Mothers Children and Adults , University Hospital of Modena , Modena , Italy
| | - Donatella Venturelli
- c Transfusion Medicine Department , University Hospital of Modena , Modena , Italy
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Mandese V, Marotti F, Bedetti L, Bigi E, Palazzi G, Iughetti L. Effects of nutritional intake on disease severity in children with sickle cell disease. Nutr J 2016; 15:46. [PMID: 27130184 PMCID: PMC4851811 DOI: 10.1186/s12937-016-0159-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/14/2016] [Indexed: 11/17/2022] Open
Abstract
Background Children with Sickle Cell Disease (SCD) may show growth failure in comparison to healthy peers. Many factors as hematological status, endocrine and/or metabolic dysfunction, and nutritional status, may play an important role in growth failure. The aim of this study was to assess whether impaired growth and nutritional intake can affect SCD severity during childhood. Methods We conducted an observational study on children with SCD referring to our clinic for routine follow-up visits in a 6-month period. We collected information on weight, height and body mass index (BMI) and calculated their respective standardized scores (z). The nutritional intake was assessed through the last 24-h recall intake of total calories, macro- (proteins, lipids, carbohydrates) and micronutrients (calcium, iron, phosphorus, vitamins B1, PP, A, C, B2). Disease severity was assessed through total hemoglobin (Hb) and fetal hemoglobin (HbF), and lactic dehydrogenase (LDH) levels, and through the total number and days of hospitalizations, as well as the lifetime episodes of acute chest syndrome (ACS). Results Twenty nine children (14 males, 15 females) with SCD were enrolled; their mean age was 9.95 years (SD 3.50, min 3.72, max 17.18). Z-weight and z-BMI were significantly directly related to total Hb. Food intake resulted significantly unbalanced in terms of total calorie intake, macro- and micronutrients, especially calcium, iron, vitamin B1 and C. Low intake of calcium and vitamin B1 were significantly inversely correlated with number and days of hospitalizations per year. Protein, lipid, phosphorus, and vitamin PP intakes resulted adequate but were inversely correlated with number and days of hospitalizations. Carbohydrate, lipid, iron, phosphorus, vitamins B1 and B2 intakes were significantly inversely correlated to HbF levels. Conclusions This study showed that, in our population, inadequate nutritional intake, weight and BMI have a significant impact on SCD severity indices.
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Affiliation(s)
- Valentina Mandese
- School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, 41124, Italy
| | - Francesca Marotti
- School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, 41124, Italy
| | - Luca Bedetti
- School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, 41124, Italy
| | - Elena Bigi
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41124, Italy
| | - Giovanni Palazzi
- Oncology and Hematology Pediatric Unit, Department for Maternal and Child Integrated Activities, University Hospital of Modena, Modena, 41124, Italy
| | - Lorenzo Iughetti
- School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, 41124, Italy. .,Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena, and Reggio Emilia, Via del Pozzo 71, Modena, 41124, Italy.
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Iughetti L, Bigi E, Venturelli D. Novel insights in the management of sickle cell disease in childhood. World J Clin Pediatr 2016; 5:25-34. [PMID: 26862499 PMCID: PMC4737690 DOI: 10.5409/wjcp.v5.i1.25] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/13/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Abstract
Sickle cell disease (SCD) is a life-threatening genetic disorder characterized by chronic hemolytic anemia, vascular injury and multiorgan dysfunctions. Over the last few decades, there have been significant improvements in SCD management in Western countries, especially in pediatric population. An early onset of prophylaxis with Penicillin and a proper treatment of the infections have increased the overall survival in childhood. Nevertheless, management of painful episodes and prevention of organ damage are still challenging and more efforts are needed to better understand the mechanisms behind the development of chronic organ damages. Hydroxyurea (Hydroxycarbamide, HU), the only medication approved as a disease-modifying agent by the United States Food and Drug Administration and the European Medicines Agency, is usually under-used, especially in developing countries. Currently, hematopoietic stem-cell transplantation is considered the only curative option, although its use is limited by lack of donors and transplant-related toxicity. SCD symptoms are similar in children and adults, but complications and systemic organ damages increase with age, leading to early mortality worldwide. Experts in comprehensive care of young patients with SCD, especially those approaching the transition age to adulthood, are missing, leading people to rely on urgent care, increasing health care utilization costs and inappropriate treatments. It would be important to establish programs of comprehensive healthcare for patients with SCD from birth to adulthood, to improve their quality and expectancy of life.
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Giugni A, Giuntoli L, Del Corso F, Mengoli F, Volpi A, Bigi E, Menarini M, Maioli A, Grazia M, Simonetti C, Turriziani I, Chieregato A, Gordini G. Paediatric versus adult trauma car accidents mortality in a northern Italy trauma system. Scand J Trauma Resusc Emerg Med 2013. [PMCID: PMC3665543 DOI: 10.1186/1757-7241-21-s1-s2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lucaccioni L, Bigi E, Garcinuno CC, Paolucci P, Iughetti L. Incidental diagnosis of thoracic ganglioneuroblastoma in a 3-year-old female with wheezing. Acta Biomed 2012; 83:53-55. [PMID: 22978059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Ganglioneuroblastoma (GNB) is a cancer of the peripheral sympathetic nervous system and represents the 30% of cases of Neuroblastoma. When originates from thoracic ganglia it may appear very late, with severe symptoms like respiratory distress or neurological dysfunctions. We present an incidental diagnosis of thoracic GNB, discovered by a chest radiography during a recurrent wheezing unresponsive to bronchodilators. The early diagnosis allowed a precocious treatment probably improving the outcome.
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Affiliation(s)
- Laura Lucaccioni
- Department of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy
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Semeraro F, Carloni A, Marchetti L, Sandroni C, Lanfranco G, Di Bartolomeo S, Bigi E, Barelli A, Scapigliati A, Boverio R, Gianolio M. Advanced life support and pre-hospital trauma care database course web-based data manager. Resuscitation 2008. [DOI: 10.1016/j.resuscitation.2008.03.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sangiorgi A, Bigi E, Luppi A. [Pseudomonas aeruginosa meningitis in a 4-month-old girl, cured with antibiotic and autovaccine therapy]. Minerva Pediatr 1981; 33:67-71. [PMID: 7242479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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